Maximize Your Reimbursement for Discography

Discography is a procedure that is mainly done for diagnostic purposes and not for a therapeutic purpose. Remember that you are doing per disc procedure/injection using CPT Code 62290 (Lumbar/Sacral) and 62291 (Cervical/Thoracic). You bill per level L1-L2, L2-L3, L4-L5.

Many providers bill for 62290 (let's say for herniated disc )- 1st level for one unit and the additional level with the same code 62290 and they would append the 51 Modifier for Multiple Procedure. Meaning, they usually bill two lines on the claim, 62290 (1 unit), second line, 62290-51 for multiple procedure. Many would also append modifier -59 for Distinct Procedure modifier.

Well, with my experience, it's a big difference when I simply bill 62290 x 3 units (for 3 levels) without of course the modifier 51 or 59.

See the difference, if the payor denies additional levels, contact the insurance company. Take a look at their policy and guidelines on billing discography. But I know many insurance companies pays well with this kind of billing and coding discography.

By the way, use CPT Code 72275 for the radiology code. One unit for one region. Two units for two different regions (for example on Lumbar and Cervical). Append Modifier -26 if done in the ASC (Ambulatory Surgical Center) or at the Outpatient Hospital.

Billing Tips: Electronic Billing. Don't Just Read the Verification Report. Read the Response Report Too!

You thought Electronic Submission of Claims do not make mistake? or do not have any glitch? error? You are absolutely wrong.

I have seen medical offices who ONLY relies on the Verification report. Well, this is a report being generated after you send your claims electronically. It usually shows you a passed or reject claims on the report. The truth of the matter is, based on my experience, I can not rely on this verification reports alone.

Getting on top of your Response Report is more essential than just relying on your verification report. This is the report that will show on each insurance company with each claim with patients' names and date of service(s) if they were "accepted", "adjudicated", "received by payor". This is actually your real response report.

When your claims get denied for untimely filing and your system shows you have submitted the claim electronically. The insurance company will require a PROOF.

Your Proof is the response report that indicates "accepted" or "received by payor". If you don't have this proof. There is no way you can appeal your claim. And your physician will not be happy for not being paid for the services he rendered to his patients.

So be very careful on this. It's important you pay attention on these reports.

BillingTips: The Same tax ID Number. The Same Specialty with many Providers.

Here's another scenario: A medical practice who has 5 Pediatricians. The same group that bills under one the same tax ID number.

Pediatrician A saw a New Patient today. After 2 weeks, Pediatrician B sees the patient for follow up. Would Pediatrician B bills for New Patient?

The answer is NO. This kind of scenario, billing for 5 different providers with the same specialty is interchangeable. Meaning, you don't bill for New Patient for a follow up visit when another Pediatrician under the same group, same tax ID number sees a patient. That patient becomes an established patient.

Billing Tips: MultiSpecialty Practice. New Patient versus Established Patient

I am so in the mood of writing on medical billing tips. Now, am going to talk about how to bill for multi specialty practice. New Patient versus Established Patient.

Well, I would assume you guys are billing on one the same tax ID number as a group of multi specialty practice.

An Internist within the group refers a patient to a Cardiologist, say, for a second opinion. The Cardiologist belongs to the same multi-specialty practice. Would the Cardiologist bill for a New Patient or Established Patient since she/he belongs to the same group?

The answer is -- the Cardiologist must bill for a New Patient even if he belongs to the same group.

I hope this may help many who gets confused on this scenario.

Billing Tips: Insurance Payment paid 100% of Charged Amount

I wanted to write about this most of the time overlooked scenario on medical billing. For instance, you billed a New Consult code using 99244 and you billed $90 for that code. Your EOB came back with a paid amount of $90.00. The biller was so happy after seeing the claim has been paid at 100% of what the office had billed.

Honestly, if I see EOB like this, I will be very very nervous! I could have been paid more than what I have charged.

TrailBlazer (State of Texas) could have allowed $170.40 for CPT 99244, how much did you lose on this claim? --- $80.40!

New York Part B allows $164.8, how much did you lose? ---- $70.80.

Now, here's the deal! --- if you get paid at 100% based on your charged amount you should find out about your fee schedule or contracted rate. Make sure you know you are not undercharging the insurance company.

But if you did undercharge the insurance company and wants that money back, ofcourse by all means, you can recover that money! Based on my experience, you can go back as far as 3 years from the date the claims were paid. I haven't tried more than 3 years of claim to recover due to undercharges! Afterall, when the insurance company overpays you and discovers the overpayment, they can always go back as far as more than 3 years I think. Or depending on where state you are located.

Pay attention on your EOBs! I think that's the key. As soon as you discover there is an undercharging and you were paid 100% on your charged amount. Pick up the phone and call that insurance company!